Costamagna G, Pandolfi M, Mutignani M, Spada C, Perri V
Digestive Endoscopy Unit, Department of Surgery, Catholic University, Rome, Italy.
Gastrointest Endosc. 2001 Aug;54(2):162-8. doi: 10.1067/mge.2001.116876.
Endoscopic dilation with stents has been proposed as an alternative to hepaticojejunostomy for management of postoperative biliary strictures. Good long-term results with double 10F plastic stent insertion for 1 year have been reported in 74% to 90% of cases. This is a review of our experience with a more aggressive approach.
The technique, short-term results, and long-term results of placement of increasing numbers of stents until complete disappearance of the biliary stricture are reported. At each exchange, the maximum possible number of stents in relation to the tightness of the stricture and diameter of the bile duct were inserted. All stents were removed at the end of treatment.
The records of 45 of 55 patients with postoperative biliary strictures treated in this manner and observed consecutively were reviewed retrospectively. By intention-to-treat analysis the success rate was 89% (40/45). Early complications developed in 4 (9%) patients (3 cholangitis, 1 pancreatitis) and stent occlusion that required early exchange occurred in 8 (18%) patients. There was 1 death caused by a stroke 2 months after a stent exchange. Forty-two patients completed the protocol (mean number of stents 3.2 +/- 1.3; range 1-6). Mean duration of treatment was 12.1 +/- 5.3 months (range 2-24 months). Two patients died of unrelated causes during follow-up. Among the remaining 40 patients there was no recurrence of symptoms caused by relapsing biliary stricture at a mean follow-up of 48.8 months (range 2-11.3 years). One patient sustained 2 episodes of cholangitis but without stricture recurrence.
This more aggressive approach to endoscopic treatment with stents may improve long-term results for patients with postoperative biliary strictures.
内镜下支架扩张术已被提议作为肝空肠吻合术治疗术后胆管狭窄的替代方法。据报道，74%至90%的病例采用双10F塑料支架置入1年可取得良好的长期效果。本文回顾了我们采用更积极方法的经验。
报告了放置越来越多支架直至胆管狭窄完全消失的技术、短期结果和长期结果。每次更换时，根据狭窄的紧密程度和胆管直径插入尽可能多的支架。治疗结束时取出所有支架。
回顾性分析了以这种方式治疗并连续观察的55例术后胆管狭窄患者中的45例记录。按意向性分析，成功率为89%（40/45）。4例（9%）患者出现早期并发症（3例胆管炎，1例胰腺炎），8例（18%）患者发生需要早期更换的支架堵塞。1例患者在支架更换后2个月因中风死亡。42例患者完成了方案（平均支架数量3.2±1.3；范围1 - 6）。平均治疗持续时间为12.1±5.3个月（范围2 - 24个月）。2例患者在随访期间死于无关原因。在其余40例患者中，平均随访48.8个月（范围2 - 11.3年）时，未出现因复发性胆管狭窄引起的症状复发。1例患者发生2次胆管炎发作，但无狭窄复发。
这种更积极的内镜支架治疗方法可能改善术后胆管狭窄患者的长期效果。
